The presidential election sent shock waves throughout the country. But there was another notable, quieter shift last week: Republicans increased their domination of state government.

The GOP now controls the state House, state Senate and governor's office in 25 states. Democrats, by contrast, fully control just five states. In addition, three states shifted from Democratic governors to Republican ones. After inauguration, there will be 15 Democratic governors and 33 Republican governors (Alaska's governor is an independent, and the results of North Carolina's race are still unknown).

President-elect Donald Trump ran on a campaign pledge to repeal and replace Obamacare. Since his election, however, he has expressed willingness to keep parts of Barack Obama's signature health reform law. What he will actually do is unpredictable, much like him. 

In the meantime, Missouri, New Hampshire and Vermont -- which will all have GOP governors come January -- may be dealing with their own health-care overhauls.

We talked to health policy experts in those states about what they expect for the future in terms of Medicaid expansion, abortion and more.


In the Show Me State, Democrat Jay Nixon presided over Missouri politics for the past eight years with a centrist touch, largely because he had a Republican Senate and House to contend with. 

Nixon favored Medicaid expansion, one of the tenets of Obamacare, and urged the legislature to pass it. But he dropped the issue once it was clear it didn’t have the support. 

Gov.-elect Eric Greitens, a former Navy SEAL who has never held political office, ran on the outsider platform that also helped Trump sail to victory in the state. His anti-Obamacare stances will likely keep much of Missouri's health-care policies running business as usual.  

“Even if the federal government decides to cut funding for Medicaid [expansion], that’s not going to impact us much since we never expanded,” said Karen Edison, director of the Center for Health Policy at the University of Missouri. 

And even if the Trump administration retains Medicaid expansion, the chances of Missouri adopting it would likely be next to none.

Health policy experts in the state, however, will be watching abortion access. The state is down to only one abortion provider. Nixon vetoed a bill mandating a 72-hour waiting period before women can get an abortion, but the GOP-controlled legislature overrode it. Any more anti-abortion legislation coming down the pike, though, is likely to get signed -- this time by Greitens, who campaigned on an anti-abortion platform.

New Hampshire

The Granite State made history by picking Chris Sununu. At 42, he's the youngest person in the country to be elected governor. Though he's a Republican, he's not health policy experts' biggest concern in the state.

Brendan Williams, president of the New Hampshire Health Care Association, said his “federal worries are transcendent right now.” 

“D.C. is very remote for us most of the time. Sometimes things will come out of Centers for Medicare [and Medicaid] Services that concern us, but we’re never really worried about Congress. Now we are,” he said.  

If Trump changes Obamacare, Williams at the least expects him to instate work requirements for Medicaid -- a request that Republican-led states continually got rejected from the Obama administration.

New Hampshire expanded Medicaid using a waiver that enrolled newly-eligible recipients into the private marketplace. Though Sununu has been a documented critic of the state's Medicaid expansion, it's unlikely that it would crumble in New Hampshire if the federal government upheld it because the Republican-controlled legislature largely favors it. New Hampshire state Senate majority leader Jeb Bradley has said that expansion is "part of the cure" of the state's opioid epidemic.

On abortion, Sununu voted against state funding of Planned Parenthood after now-discredited videos were released of a Planned Parenthood official discussing the sale of fetal tissue. But he walked back his stance this year and voted in favor of funding Planned Parenthood. 


Vermonters say that party affiliations don’t mean much to them. The state that just elected Republican Phil Scott as governor is also home to Bernie Sanders, an independent senator who ran a presidential campaign on a socialist-inspired platform. 

Vermont has the second lowest rate of uninsured residents in the country at only 3.8 percent. So health officials there have shifted their attention to the cost of health care.

Just before the election, the state finalized plans to become the first in the country with a comprehensive all-payer model. That means health providers, if they choose, can be paid a fixed rate instead of for each service they provide. 

“We’re moving to a population health model, where we’re promoting wellness,” said Jeff Tieman, president of Vermont Association of Hospitals and Health Systems.

But the state's new governor has criticized the plan, signaling that its future may be in jeopardy.

“We simply cannot afford any more expensive and unsuccessful health-care experiments,” he said in October. (The state recently spent years of time and money trying to shift to a universal single-payer form of health care but eventually abandoned the effort.)

Still, Tieman isn’t worried about Scott upending the state’s health care. Scott is pro-abortion rights and for the preservation of Medicaid expansion.

“I do imagine he’ll address the all-payer model in one way or another. There are disagreements here, but people are just more collaborative. Politicians are more focused on making life better for all Vermonters,” he said.